Coarseness of facial features is detected with acromegaly, mucopolysaccharidoses, progressive leprosy. Some coarseness of features can be seen with the development of the viril syndrome during the period of growth, chronic alcoholism. Isolated coarsening of the nose is observed in patients with rhinophyma. To determine the cause of the symptom, a survey, physical examination, MRI, x-ray, hormone tests, and other laboratory tests are carried out. Treatment may include the appointment of hormonal agents and other drugs, surgical interventions.
Normally, the features are somewhat coarsened with age due to the appearance of wrinkles and an increase in facial relief. The process occurs so slowly and gradually that it does not cause concern either for the person himself or for those around him. The change in traits is more noticeable with the muscular type of aging, which is rare in Caucasians and more characteristic of representatives of the Mongoloid race.
Outwardly, facial features become coarser under the influence of bad habits, work in adverse weather conditions, however, the normal proportions of facial structures are preserved. Sometimes a transient external effect of coarsening is created due to puffiness.
Pronounced coarsening of facial features is a characteristic sign of acromegaly. Due to an excess of growth hormone, certain parts of the body of adults begin to increase. Typical symptoms of acromegaly are hypertrophy of the mandible, cheekbones, brow ridges, ears, nose, and lips. Not only the structures of the face increase, but also the skull as a whole, the old headgear becomes small for the patient. The feet and hands also hypertrophy, which entails a change in the size of shoes and gloves.
Coarsening of facial features with acromegaly
Coarseness of facial features is determined in all types of mucopolysaccharidosis. Depending on the form of the disease, the first changes appear at the age of 1 to 3-5 years. Along with coarse facial features, growth retardation and skeletal deformities attract attention. Often there are scoliosis, kyphosis, changes in the shape of the chest, contractures of the joints of the extremities. In some types of the disease, mental retardation, frequent hernias, or diseases of the respiratory system are found.
The symptom is most pronounced in patients with lepromatous leprosy. Generalized skin syndrome and diffuse infiltrative changes cause deepening of natural folds and mimic wrinkles. The nose, cheekbones and superciliary arches thicken, the patient's face acquires the characteristic appearance of a "lion's muzzle". In the tuberculoid form of the disease, the coarsening of facial features is hardly noticeable; in the borderline and undifferentiated forms, there are no changes.
Viril syndrome itself does not lead to coarsening of facial features, but if the pathology develops in childhood or adolescence, this can affect the formation of facial structures. As a result, facial features are coarsened, become unfeminine, reminiscent of men. A similar picture can be observed with hyperandrogenism against the background of androgen-producing tumors of the ovaries and adrenal glands. The symptom is combined with the absence or late appearance and irregularity of menstruation, infertility, acne, hirsutism, male-type fat deposition.
Characteristic puffiness and edema, located mainly in the area of the eyelids and wings of the nose, combined with premature signs of aging, make the face of an alcoholic rough, neutralize individual differences. The coarsening of facial features is more noticeable in women. Other external signs of alcoholism are cyanosis of the skin, spider veins on the cheeks and nose, yellow tint of the sclera, decreased muscle tone, and swelling of the distal extremities.
Due to the growth of the skin, the nose increases in size, loses its usual shape, becomes knotty, cone-shaped. Due to the uniform increase in all structures of the nose, the sebaceous glands become unusually large, secrete a lot of secretion. Due to dilated blood vessels, the nose turns blue or acquires a purple hue. The growth of the nose with rhinophyma occurs in waves, lasting up to several years. Other parts of the face do not change.
Chalazodermia is a developmental anomaly that occurs in some congenital diseases. The skin is pasty, flaccid, easily retracted, forming large coarse folds, due to which the face of the patient resembles the muzzle of a bulldog or a hunting dog. The features themselves do not change, but due to the specific condition of the skin, the face looks rough, “heavy”.
Endocrinologists are most often involved in establishing the causes of coarsening of facial features. Taking into account the identified symptoms, the patient can be referred for a consultation with an orthopedist, infectious disease specialist, dermatologist. During the interview, the specialist finds out when the symptom appeared, which parts of the face underwent changes, how quickly the manifestations progressed.
As part of an external examination, the doctor evaluates the proportions of the face and body, detects an increase in the size and deformation of individual structures, and reveals other symptoms: infiltrates, blue or redness of the skin, dilated vessels. Women undergo a gynecological examination. The program of additional examination may include:
Examination by an endocrinologist
The tactics of conservative therapy is determined by the etiology of coarsening of facial features:
Pituitary tumors that cause the development of viril syndrome and acromegaly are removed surgically. In the case when the virile syndrome is caused by polycystic, cauterization, demodulation or wedge resection of the ovaries is performed. Androgen-secreting neoplasms of the adrenal glands and ovaries are excised. With mucopolysaccharidoses, hernia repair, correction of deformities and contractures are carried out.